Burnout and Renewal: Changing Perspectives in Neurosurgery

ma3Guest post from Joseph C. Maroon, MD
Clinical professor and vice-chairman of the Department of Neurological Surgery and the Heindl Scholar in Neuroscience at the University of Pittsburgh Medical Center
Pittsburgh, PA

Today, 57 percent of neurosurgeons currently report “burnout” in their career. It is time we recognize this common burnout as a very serious and very preventable issue. I experienced it myself, after enjoying a career filled with accolades, accomplishments, and success. In my early 40s, I began a frightening descent into depression.

For me, it was my unidimensional commitment to become the best neurosurgeon I could be that insidiously led to complete imbalance in my life. Ten years after finishing residency, I’d really only succeeded in ruining a marriage, losing any sense of purpose in my work, and becoming physically and emotionally exhausted.

Fortunately, I recognized the adversity I faced was a powerful opportunity, and I learned from my experience. I eventually recovered and returned to my neurosurgical career, and six years later, I stood in front of the Congress of Neurological Surgeons (CNS) to give a presidential address. In my talk, I shared the four important “sides” of life:

  • Work;
  • Physical health;
  • Spirituality; and
  • Relationships.

book 2In my latest book, Square One: A Simple Guide to a Balanced Life, I recount my own story of adversity and how I ultimately re-balanced my life by embracing all four sides of life. I also have the privilege of sharing the stories of three other amazing people who represent the best of balanced living: Rajesh Durbal, the only triple-amputee to complete the Kona Ironman World Championship; Dr. Elizabeth Tyler-Kabara, a Pittsburgh neurosurgeon with a successful career and beautiful family; and Sam Hazo, poet and professor emeritus.

Square One addresses how to control the stress of our busy and demanding careers, how balanced living can help prevent many of the chronic diseases of aging, and how creativity, humor, and purpose can affect our health span — not just our life span.

Today, I have rediscovered the excitement and rewards of caring for others, the importance and fun of new research projects, and the undeniable benefits of empathy and stimulating friendships. I live with daily gratitude for everything adversity taught me.

I encourage neurosurgeons to turn and look toward one another to see examples of the resiliency, compassion, and humility needed in times of adversity — both in the operating room and in life. If you’d like to use Square One as your guide, learn more about it here.

Editor’s note: The content of this post originally appeared in the Congress Quarterly which is a publication of the Congress of Neurological Surgeons (CNS).

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Medical Student Reflections: My Health Policy Journey

mike 4Guest post from Michael J. Strong, MD, PhD
Neurosurgery Resident, University of Michigan

Health policy has been an interest of mine even before medical school. With my acceptance letter to Tulane Medical School in one hand and my diploma from the Master of Public Health program at Tufts University in the other, I began my exploration into the realm of health policy during the summer of 2009. As a recent graduate of public health at the time, I wanted an opportunity to apply my training in the “real world.” I looked into several opportunities but ultimately was able to line up an opportunity to work in the Office of the Surgeon General in Washington, DC. This was my first experience at applied health policy and public health, and there was no better place to experience health policy firsthand than in our nation’s capital.

Now, fast-forward eight years (yes, it took me a little longer to graduate from medical school — I made a pit stop to get a PhD along the way), and as serendipity would have it, I found myself back in Washington, DC partaking in issues related to health care and health policy. This time around, I had the fortunate opportunity to work on Capitol Hill on issues that have a direct impact on our health care system.

cass 3Being a medical student studying in Louisiana, it was natural for me to work with a Congressman from my current state. As an added bonus, not only is Senator Bill Cassidy from Louisiana, he is a physician —  one of only 15 currently serving in the United States Congress. Although Dr. Cassidy no longer practices medicine in the formal sense, he is still very much in tune with health care related issues as reflected by his congressional staff. I would even argue that he continues to practice medicine, now on a more global scale, in policies that help shape our current health care system.

Reflecting back on my experience working in Senator Cassidy’s office, this was the ideal time for me to engage in health policy during the heated debate surrounding the state of our current health care system. Jumping from one meeting to the next, listening to the specific requests from various advocacy groups, I tried to learn as much as I could while keeping up with his staff. From discussions involving the current status of the Zika virus outbreak to mental health training for law enforcement, I tried to get involved in everything related to health care. All in all, I made great strides in learning how the health policy arena operates, but as with many things, my rotation came to an end. One thing is for sure, the opportunities bestowed upon me during this rotation will shape my career in neurosurgery and how I practice medicine. I believe my time was well spent, and I would highly recommend this rotation to all medical students.

As I drove away from Washington DC, with the city in my rearview, I couldn’t help but reflect back to where my journey in health policy began all so long ago. It was only fitting that I finish my medical school career in the same vein as how I started — engaging in health policy in our nation’s capital. Now, with my match letter to the University of Michigan in one hand and endless possibilities in the other, my journey into health care policy is far from over. Just maybe I will find myself back in Washington, DC again.

hhs 3

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Image Gently: A Pediatric Neurosurgical Perspective

gasGuest post from Sarah J. Gaskill, MD
Professor, College of Medicine Neurosurgery and Department of Neurosurgery and Brain Repair at University of South Florida
Chairman, AANS/CNS Section on Pediatric Neurological Surgery
Tampa, FL

The Think-A-Head Image Gently Campaign rolled out last year, as a multispecialty campaign under the umbrella of the Image Gently Alliance, an organization for education and awareness. It has grown exponentially, with more than 100 health care organizations and agencies participating, including more than 35 internationally, amounting to more than one million professionals worldwide.

Image Gently is a communication campaign which benefits the market and not the “marketers,” with a goal to use only the necessary radiation dose in children. This is a critical issue for several reasons:

  • Children are more radiosensitive than adults, due to their growing tissues and developing central nervous system.
  • The Lancet article in June 2012, “Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study” represented the first association with prior CT scans and cancer, and has fueled the public and specialty debate about imaging particularly with CT in the pediatric population.
  • As pediatric neurosurgeons, we care for many patients with lifelong, chronic illnesses including shunted hydrocephalus.
  • Any child with a shunt is subject to the frequent policy of a CT and shunt series every time they have an office visit, or every time they show up in an emergency department.
  • Replacing a CT for the evaluation of a shunt with a rapid sequence MRI gives us the advantage of a quick, non-sedated, no radiation look at the ventricles for the evaluation of a shunt.

gentlyAll physicians need to be aware of the radiation exposure associated with diagnostic tests and make a decision: Is this truly necessary? Will the results of this test change the management of this patient in a meaningful way? Could I get this information without using a diagnostic test that requires radiation?

It is for these reasons that the AANS/CNS Section on Pediatric Neurological Surgery became a sponsor of the Think-A-Head Image Gently Campaign. This campaign is for physicians and parents. The goal of the campaign is to “help providers appropriately obtain and perform computed tomography (CT) scans in children with minor head injuries.” Here are some tips to consider.


  • Order CT scans in minor head injuries based on the latest evidence-based medical guidelines;
  • Explain to parents why an image is (or is not) necessary;
  • Discuss possible alternative exams;
  • Discuss the risks and benefits of the CT scan; and
  • Use child-size radiation dose where appropriate.


  • Ask if the exam will help improve your child’s care;
  • Ask the risks and benefits of the test;
  • Inquire if there alternate tests that do not use radiation, such as MRI; and
  • Ask what your child will experience during and after the examination.

For all neurosurgeons, it is important to remember that no level of radiation exposure is without consequence. If a study is necessary for the care of the patient, it is justified. If the information gathered from a radiographic study will not change the management, then it likely should not be obtained. I’m sure we can all do better with less imaging. So, remember to Image Gently.

Editor’s note: The content of this post originally appeared in the Congress Quarterly which is a publication of the Congress of Neurological Surgeons (CNS).

Posted in CNS Spotlight, Pediatrics | Tagged , , , , , , |